Meetings of Societies.

Dr Joseph Bell showed a calculus about the size of a pea, which he had received from Dr Cowie of Lerwick. The patient had been under treatment in Edinburgh five years ago, for foetid bronchitis, simulating gangrene of the lung; had continued very ill till a few weeks ago, when he expectorated this calculus, and now all his symptoms have diminished. The calculus had been analyzed by Dr Crum Brown, and found to contain phosphate and carbonate of lime in a very slight organic matrix.

Mr Annandale showed six calculi and the fragments of a seventh, the first of which he had removed from the urethra with forceps and the latter from the bladder by means of a lithotrite. The patient from whom these calculi were removed was a gentleman, set. 26, who had had symptoms of stone for only four months, and at the time of the operation was suffering from complete retention of urine.
Mr Annandale also showed the fragments of a stone which he had removed by the operation of lithotrity from a patient, 72 years of age, who had been the subject of lithotomy ten years before.

III. CALCULUS FROM THE LUNG.
Dr Joseph Bell showed a calculus about the size of a pea, which he had received from Dr Cowie of Lerwick. The patient had been under treatment in Edinburgh five years ago, for foetid bronchitis, simulating gangrene of the lung; had continued very ill till a few weeks ago, when he expectorated this calculus, and now all his symptoms have diminished. The calculus had been analyzed by Dr Crum Brown, and found to contain phosphate and carbonate of lime in a very slight organic matrix.
Dr Joseph Bell showed a salivary calculus about the size of a field-bean, which he had lately removed from a young lady aged 18. She had suffered from a tumour under her tongue for more than a year; at first it had been painless, but for the last two months it had been painful, fungated at the top,, and caused much alarm. The tumour, which was nearly as large as a walnut, had thick walls of a fibro-cartilaginous consistence. Removal of the calculus soon caused the tumour to disappear. Dr Joseph Bell showed a piece of an anvil, weighing about a quarter of an ounce, which he removed from the inside of the globe of the left eye of a young man.
He had travelled more than 200 miles without being aware that any foreign body was present. He made a good recovery, with loss of vision in the injured eye.
VI. Dr Paterson of Leith read a paper ON A CASE OF INTESTINAL CONCRETIONS, which was published in our last Number, vol. xiii. p. 1067. Dr G. Balfour remarked that similar concretions in the horse resulted from barley-dust, composed of the caryopsis and outer husk of the grain removed in making pot and pearl barley. He could not agree with Dr Paterson in ascribing the concretions in the case he related to the enemata of oatmeal-gruel and oil, for the reason that oil prevented the felting of fibres, and was in fact employed in woollen-mills for that purpose. He thought the concretions had been formed in the usual way, from the oatmeal-porridge taken as food.
Mr Annandale had a few years ago met with a fatal case of intestinal concretions. At one part of the small intestine two concretions meeting together had entirely blocked up the passage, producing the symptoms of complete obstruction and death from peritonitis. On post-mortem examination, the small intestines were found matted together by recent lymph, and it was observed that one of the concretions had, by giving rise to ulceration, caused the peritonitis. The subject of the disease was in the habit of feeding pigeons with oats, but had never taken porridge.
Dr Halliday Douglas, with every deference to the opinion deliberately arrived at by Dr Paterson, was unable to agree with his conclusions. He remarked particularly, that though there was abatement, there was no complete cessation of the symptoms after the discharge of the plum-stone. He inclined, therefore, to the view that the concretions had been formed in the ordinary way from the oatmeal diet, antecedently to the use of the enemata of oatmealgruel and cod-liver oil.
VII. Dr Halliday Douglas then read the account of a CASE OF PLASTIC BRONCHITIS, WITH quasi DIPHTHERITIC EXUDATION, which will be found at p. 1.
Dr Sanders remarked on the interesting nature of the facts as recorded. Cases of acute plastic bronchitis were rare. He inquired if the urine had been found albuminous? Dr Douglas said that it had not been examined. Dr Warburton Begbie had showed to the Society, about four years ago, casts of the bronchial tubes from a case then under his care. The patient, a young woman, suffered from diphtheritic affection of the throat, and the lung became subsequently involved. In this case there was not, as in Dr Douglas's, any pneumonic consolidation. The chief stethoscopic sign was absence of respiration in the affected part. The expectoration took place in masses, which on examination exhibited moulds of the bronchial ramifications.
In this case diphtheritic paralysis came on subsequently. The patient made a complete recovery.
Dr Douglas drew attention to this fact, that, in his case, the lung affection appeared to precede the exudation of the throat, and could not be regarded as a sequela of diphtheria, which was the case in Dr Begbie's patient; and although two of the children had diphtheria in the patient's house a year before, he did not think the case diphtheritic.
Dr D. Gordon mentioned, that in a recent autopsy of a child who had died of diphtheria of the throat, the bronchial tubes in the lungs had been found filled up with exudation.

1868.]
MEDICO-CHIKURGICAL SOCIETY OF EDINBURGH. 89 VIII. Dr G. W. Balfour read a paper ON THE TREATMENT OF ANEURISM BY MEANS OF IODIDE OF POTASSIUM, which will be found at p. 33.
Dr Joseph Bell mentioned that, in the case of a female suffering from chronic bronchitis, and who was the subject of an aneurism of the arch of the aorta, which formed a tumour under the right breast, he had found a remarkable diminution in the size of the tumour, which became one-third smaller and considerably firmer after six weeks' treatment with the iodide of potassium in fifteen-grain doses. The patient, from being confined to bed, was able to get up and walk about.
Dr Douglas remarked that, although his experience of the results of the treatment by means of iodide of potassium had not made a particularly favourable impression on his mind, the full and candid account of the whole subject given by Dr Balfour would induce him to submit the proposed treatment to further consideration and trial. 13th May 1868.?Dr Bryce, and afterwards Dr Burn, in the Chair. I. Dr Bryce showed a portion of an umbilical cord, on which there was a knot. The child had been born alive. He remarked that the chief point of interest in connexion with the specimen, was as to when the knot had been tied.
Dr Cochrane was of opinion that the knot had been formed during delivery. Dr Cappie said he had seen a case the other day in which a woman gave birth to twins: one of the children was dead born, and there was a knot on the cord of the dead child.
Dr Matthews Duncan remarked that he had seen such knots repeatedly; and in the cases which had come under his notice, the children were all born alive. He was of opinion that such knots could not possibly all be formed during delivery. They were often very complicated. A case of twins in which the cord of one child was enclosed in a knot of the other's cord, drawn so tight as to cause the death of the first child, had been related to the Society some fifteen years ago. On the 1st October 1867,1 was requested to visit Mrs W., aged 30, mother of three children, and then about three months pregnant for the fourth time.
She had a troublesome, hacking, dry cough, and impeded respiration, both of which were much aggravated by exertion, and she was very weak. Fine crepitation and slight dulness on percussion indicated the presence of commencing tubercle in the apex of the right lung. During the course of her pregnancy the disease advanced and involved nearly the whole of the right lung, but the left remained remarkably sound. She suffered much from irritability of the stomach. Whenever she took food, a fit of coughing came on which almost invariably ended in vomiting. This was not confined to the VOL. XIV. NO. i. m [JULY early months of pregnancy, but continued till within four weeks of her delivery, and greatly increased the debility and emaciation consequent on the disease. Medicines failed to give relief, and the only thing that seemed to be of any use was perfect rest in bed. At last the vomiting ceased, and she could take and retain a sufficient amount of food, and even a considerable quantity of the oil of the earth nut, which was prescribed for her. This strengthened her, and enabled her to go on to the eighth month of pregnancy, when she gave birth, with the greatest ease, on the 2d of March 1868, to a small, weak, emaciated child. For two or three weeks before delivery, she exhibited signs of approaching insanity, and when that event occurred, she was in a state of acute mania, which continued till her death on the 12th March. As she was afraid of being poisoned, she refused to take food; but on one occasion she tore off her mother's cap and swallowed a portion of it, saying that we would find it in her body after her death. She was often very violent, and it became necessary to subdue her and put her asleep by means of chloroform; but, as too generally happens, when she awoke, the delirium returned, and she was as violent as before. During her delivery she was raving mad, and it was with much difficulty she could be kept in bed. On one occasion she placed herself across the bed, and for a considerable time violently pounded the wall with her feet. Both limbs became swollen below the knees, and the left one painful, cold, and pulseless. For ten days before her death, the left limb below the knee exhibited all the usual conditions of gangrene. As there was no sectio, I regret my inability to give any information as to the condition of the vessels of this limb. The child succumbed to a slight attack of diarrhoea, and died on the fifteenth day after its birth.
Dr Patlison said that he had related a somewhat similar case to the Society some time ago.
On the suggestion of Dr Inglis, it was agreed to postpone the discussion on Dr Gordon's paper till after Dr Cappie's was read. (This paper will appear in a future number of the Journal.) Dr Cochrane agreed with Dr Cappie's views, and thought the best treatment was to expedite delivery. The less bleeding the better.
Dr Pattison said he had had four cases of puerperal convulsions?two of them recovered, and two were fatal. In the first two cases, he bled largely, but, notwithstanding, the convulsions continued. In both there was albuminuria. In the third case, the woman was dying, but the child was expelled. In the fourth, he bled and delivered the child by turning. Dr Pattison remarked that there was a particular expression of countenance which almost always indicated the coming on of puerperal convulsions.
Dr Inglis, while agreeing with Dr Cappie as to the propriety of early instrumental interference in many cases, thought that there might be others in which it would be well to follow the practice recommended by Professor Dyce of Aberdeen.
Dr David Gordon said that there seemed to be no danger in applying the forceps long before the os is fully dilated, especially if Dr Cappie's forceps were used.
Mr Pridie had three cases of puerperal convulsions in 18G4. Bleeding had been practised in all of them, and they all recovered. Acetate of potass had been given freely. One of the patients only a few weeks ago complained to him of great headache; she was pregnant, and the urine was albuminous.
There was also almost complete amaurosis. The acetate of potass was given; she was confined safely of a fine child, and five days after delivery, the sight of one eye was partially restored. A gradual improvement had gone on since.
Dr Matthews Duncan, while commending Dr Cappie's paper, could not agree with it all. He thought Dr Cappie had acted wisely in limiting the subject so as to consider only puerperal convulsions coming on at the commencement of 1868.] OBSTETRICAL SOCIETY OF EDINBURGH. 91 labour. The two great questions, therefore, were,?1st, When convulsions occur at that stage, should delivery be forced? and, 2dly, Is the method recommended by Dr Cappie the best ? In regard to the first, he was not in a position to lay down a rule for all cases; but his own impression was, that so long as there were no very serious symptoms, it was as "well to wait, on account of the danger of forced labour. Besides, one never can tell with certainty when the convulsions may cease. He had had recourse to forced labour, but never used the method recommended by Dr Cappie, which, in his opinion, was only practicable with Dr Cappie's forceps. The plan, however, had been described by a well-known French author, who wrote about the beginning of this century (Hatin). In the cases in which Dr Duncan resorted to forced labour, he had followed a different plan. He considered that Dr C.'s three cases were too few to settle the question. More experience was required. He was in the habit of dilating the os, as with Barnes' bags, till he was able to introduce the hand and turn. He thought this method might in many cases be both quicker and safer than Dr C.'s. It ought to be remembered that puerperal convulsions were generally only another form of the convulsions seen in cases of Bright's disease. He was of opinion that only in the gravest cases should forced labour be resorted to. Dr Cappie's method was novel, but he was not satisfied that it was better than older procedures. He had met with cases of amaurosis associated with albuminuria, and some of them were only partially recovered from. The most fatal kind of puerperal convulsions he had seen, were cases in which the patients had been delivered under the influence of depressing emotions, where the women had been seduced. The questions connected with the theory of ursemia were numerous. Dr Ritchie thought Dr Gordon's case a good instance of insanity accompanying debility. In epileptics, the fits which, before labour, are often violent, cease during parturition. He remembered one case of this kind where the woman did well. He had seen another case of a maniac, in whom the mania abated during the period of confinement.
Dr Burn said that, as a rule, the urine was much diminished in quantity before the puerperal convulsions came on. The face was usually puffy. He had seen bloodletting in moderate quantity very useful, but of course he would not recommend this practice in every case. He did not see the possibility of introducing the forceps if the os was not dilated more than the size of a crownpiece, nor could he understand the object of invariably letting off the waters. It is well known that convulsions are frequently excited by digital examination. Dr Burn further stated that he had often had recourse to turning the child, with fair success; but, in some cases, women will succumb under any treatment.
He had seen the convulsions arrested by chloroform, and its administration also renders the uterus more dilatable.